Michael W. Brennan, MD

August 2009

While national health care reformers debate and state budget authorities default, I’d like us to stay focused: on our home front — yours and mine — and especially on our patients and our profession. This is the personal story of my group practice in mid-urban North Carolina, but I think you will find many of its themes to be familiar. While reflecting on our attempts to keep our eyes on efficiency and our minds on clinical excellence, I’ll try to highlight our professional strengths and recognize our weaknesses. I will also encourage all of us to seek the practical and productive resources of our Academy. Together we can demonstrate that our profession is more accessible, more accountable and more affordable.

Upon retirement from the military in 1986, I chose to join an established practice with partners I would trust forever. My initial two colleagues in Burlington, N.C., believed in primary eye care, and we continue this tradition today as an integrated practice of six ophthalmologists, 18 technicians, four optometrists, full-service optical with licensed opticians and an AAOE-related administrative staff.

More Accessible
Surrounded by the University of North Carolina, Wake Forest and Duke, we concentrate on primary, integrated eye care, Each of the five comprehensive Eye M.D.s incorporates some subspecialty interest, and a retina specialist providing a unique and very contemporary subspecialty-care element. We emphasize accessibility, offering same-day service and open dialogue with community physicians. We’ve never turned a patient away.

Our intake capability is enhanced by well-educated, trained and certified ophthalmic assistants and technicians, as well as licensed nurses. Due to the active integration of our technicians’ services and our confidence in their character and competence, they play an invaluable role in front-line communication and examination. This expands our time for decision-making and face-to-face patient deliberation. We also employ optometrists, who provide general examinations and expand our practice’s offerings with contact lens and low-vision services. Our AAOE collaborative administrators are management associates, who accent training and recognition, leading to long-term retention of an excellent staff, clerical, optical and clinical.

More Accountable
Accountability is shared in our practice. The partners share responsibility for the practice’s accessibility and the profession’s public representation over a wide variety of venues: business and civic communities, regional academic institutions, state regulators and legislators. We are active members of all state and national medical societies. We’re also very active in leadership development, eager to engage our next-generation partners. The North Carolina community, especially its legislators and regulators, knows that the Alamance Eye Center ophthalmologists are ready at all times as personal references for the health care considerations of our citizens. Unselfish distribution of advocacy assignments, usually by personal interest, results in equity and enjoyment while helping to maintain the accountability of our profession.

More Affordable
While we’re easily accessible and respectably accountable, I’m not as certain about our total “affordability.” I’m confident that we do not overuse, over-medicate or over-operate, with respect to Preferred Practice Patterns™ and clinical guidelines, but I believe we would enhance our efficiency and simultaneously control the cost of care with more careful record audit and peer review. We participate and conform on all carrier panels and we carefully document, but our internal assessment could be better. When I say “we,” I’m generalizing this to many of us. We must deal directly with cost control and value assurance or concede totally to outside auditors.

As my practice and yours pursue efficiency in our direct patient care, clinical education and community relations, the variety of Academy and state society resources are a tremendous source of assistance. From the O.N.E.™ Network to AAOE, from EyeNet to EyeSmart, from San Francisco to Washington, D.C., from OMIC to CODEquest, the Academy aligns an array of easily accessible services just for us.

So, be excellent, efficient and eager to serve your community. Educate and certify technicians, connect your administrator with AAOE, employ and integrate optometrists and practice full-service primary eye care. Join and support your state eye society, volunteer for an Academy advocacy opportunity and influence the legislative and regulatory decision-makers who affect your patient’s care and your profession.